Review article                                                                                     UDC: 616.348-006.6-089.85                                                                                                            doi:10.5633/amm.2015.0117

 

  

Compleate mesocolic excision and right hemicolectomy

Goran Stanojević^1,2, Milica Nestorović¹, Branko Branković^1,2,

Dragan Mihajlović¹, Vanja Pecić¹, Dejan Petrović¹

  

Clinic for General Surgery, Clinical Center Niš¹

University of Niš, Faculty of Medicine, Niš, Serbia²

 

 

                         Contact: Stanojević Goran
                        Bul. Zorana Đinđića 48, 18000 Niš, Serbia
                        stgoran1964@gmail.com

 

In order to understand the term complete mesocolic excision, the knowledge of anatomy is crucial. In the classical literature, mesenteric organ is described as fragmented and discontinuous. Total mesorectal excision (TME) has become the “gold standard” for the surgical management of rectal cancer. In describing it, Heald provided an anatomical basis for surgery. Similar description was needed for colon cancer surgery. According to the modern anatomical studies, fibers of Toldt’s fascia form a plane between the apposed portions of the mesocolon and the underlying retro-peritoneum. The demonstration of mesocolic continuity, combined with the presence of Toldt’s fascia, interposed between the apposed portions of the mesocolon and the retroperitoneum, rationalize planar dissection in colonic resection. By addressing these anatomical features, the mobilization of the entire colon and mesocolon (which remain intact) can be performed.  Hohenberger et al. used the concept of TME for colon cancer surgery and in 2009 introduced the term complete mesocolic excision (CME). The concept for CME is the consequent surgical separation by sharp dissection of the visceral fascia layer from the parietal one resulting in complete mobilization of the entire mesocolon covered by an intact visceral fascial layer, ensuring safe exposure and tie of the supplying arteries at their origin. With this technique, survival rate increased. In comparison to open CME, laparoscopic CME has comparable results. Complete mesocolic excision seems to offer a survival benefit and better local control, but none of this is proved by randomized controlled trials. Acta Medica Medianae 2015;54(1):107-112.

 

Key words: complete mesocolic excision, colon cancer, right hemicolectomy